How the pandemic has contributed to geriatric mental health issues

Dr Ryan Fuller, a psychiatrist specialising in geriatric mental health or mental health of the aged and practising at the Memory Care units at Netcare Akeso Alberton and Netcare Akeso Parktown, said people aged 65 and older are already at higher risk of memory-related mental health conditions such as dementia, which causes confusion, memory loss and difficulties in thinking.

“Approximately 5% of 65-year-olds suffer from some form of dementia, the prevalence of which doubles every five years. At the age of 70 approximately 10% will have dementia,” he said.

“Reports are indicating that long Covid-19 shows cognitive problems in the elderly that can be equivalent to dropping 10 points in IQ. Such a dramatic change in a short space of time can naturally lead to a state of confusion and frustration, further impacting their mental health,” said Fuller.

“In addition to this, elderly people who are often isolated have become even more so due to Covid-19, worsening feelings of loneliness and anxiety. We have seen an increase in psychotic depression in the form of paranoia, delusions such as imagined theft, as well as hallucinations, typically corresponding to the person’s mood,” he explained.

“In some cases, the stress of the pandemic has unmasked underlying disorders such as schizophrenia. In other cases we are seeing a new onset of psychotic disorders such as paraphrenia, where the intellect of the individual is not impacted but they display signs of paranoia and are resistant to seeking help.

“Adding to this mental illness load, in South Africa, we also see post-traumatic stress disorder (PTSD) linked to untreated trauma from events such as home invasions or hijackings, which have sometimes happened in succession without psychological assistance on how to deal with it. These individuals often suffer from severe stress, panic attacks and anxiety.”

“Depression and stress can also lead to memory-related problems and it is worth noting that untreated depression is a risk factor for dementia.

“There is no need for anyone feeling stressed or depressed to suffer in silence. It is not always easy for people currently over the age of 65 to talk about mental health but safe spaces do exist for them being able to express themselves. This can make all the difference to their quality of life and can serve to maintain connectedness between elderly individuals and their loved ones.”

Underlying factors

According to Fuller, nutritional deficiencies are not uncommon in the elderly, who may lack the energy to prepare fresh nutritious meals and have not included supplements to replace the nutrition they were previously able to obtain through their diets.

Such physical factors play a significant role in the deterioration of mental health. It can lead to enduring depression and conditions such as delirium, which could be mistaken for dementia.

“A delirious patient may present as being very confused but with the correct treatment with something as simple as a vitamin or folate supplement, their mental state can improve. If left untreated, delirium can be life-threatening.

“In the ageing population, we see a higher prevalence of chronic diseases such as high blood pressure and diabetes. These illnesses are a risk for vascular dementia, as anything happening in the heart is a reflection of what can be happening upstream in the brain, with stroke or mini-stroke being a real threat to mental health.

“Even with a mini-stroke, psychiatric intervention as early as possible is highly advisable to help address any potential cognitive deterioration. This also pertains to ensuring the physical safety of the individual, and others, as they may be at risk of leaving the stove on at home or having an accident while driving. It is imperative to conduct a psychosocial assessment before the deterioration reaches this stage.

“If the individual shouldn’t live alone, counselling with multidisciplinary teams can help to achieve the most effective outcomes in assisting both the individual and their family to adjust to new living arrangements, which can require delicate negotiation.

“We would wish to promote a sense of independence as far as possible, with the best interests of the individual being of primary concern,” he said.

Proactively seek treatment

Fuller encourages those over 65 to be proactive in not only maintaining mental well-being in daily life but also exercising their right to seek professional mental help.

“Psychotherapy is highly beneficial for older persons, even those with memory problems. Cognitive behavioural therapy, in which we talk through identifying thought patterns and figure out strategies to better manage problem areas, has been shown to improve major depression and anxiety disorders for older individuals.

“In conjunction with medication, when required, we see excellent results with people getting better faster and staying well for longer.

“For individuals who need more permanent assistance with daily life, family therapy can help in how to keep a loved one well. Through a process called active care planning, done in conjunction with a therapist or therapy team, challenges can be discussed and risks identified.

“For example, an occupational therapist can come to the home to assess the risk of falling, as well as work with the family to create a structured daily schedule. In this way, an overall improvement in lifelong health can be achieved.”

Caring for an elderly loved one

“Family members and carers with concerns about an elderly individual’s mental health need to approach the potential problem sensitively, and to spend quality time with that person to understand possible patterns,” explained Fuller.

“For example, does the problem occur most days? Does it happen in different places? Is it causing distress? Does it affect the level of functioning? If the answer to these questions is yes there may be a mental health disorder that needs evaluation and treatment.

“The first port of call should be your general practitioner, who can refer the individual to an appropriate specialist. When going for these first visits the most helpful thing you can do is to write down a clear and concise description of the perceived problem and bring along the medication being taken.

“While the primary focus will be on the elderly individual whose mental health is a concern, it is also important for carers and family members to be aware of their mental well-being when caring for an ageing loved one. Family therapy can assist in managing the adjustment to changes in daily schedules and potentially in living situations.”

Fuller noted that such conversations will always centre around the best interests of the elderly individual, but this does not mean that the well-being of family members is unimportant.

“Those who are closely involved in the care of an ageing loved one should practise self-compassion and seek mental help to assist with the additional strain that this may place on them. This can be highly beneficial in helping to maintain well-being in the mind and the home.

“Seeking mental help is a step by step process of identifying potential problem areas and finding solutions, using proven methods with the support of professionals.

“Our bodies age and so do our minds. It only makes sense to do what we can to maintain good health in all areas of life and to reach out for help when we need it,” Fuller concluded.